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79 Cards in this Set
- Front
- Back
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primary is most common
multifactorial disorder that’s often genetically determined OU; insidious onset; slow progression; “thief in the noc” chronic open-angle’s most common cause is degenerative change in trabecular network, resulting in decreased outflow of aqueous humor |
open angle glaucoma
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IOP >24 mm. Hg
slow loss of peripheral vision scotoma [blind spot] tunnel vision persistent dull brow pain difficult adjustment to dark failure to detect color change disc cupping |
open angle glaucoma
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anatomically narrow anterior chamber angle predisposes to acute onset
unilateral, sudden blockage of anterior angle by base of iris IOP >50 mm. Hg severe ocular pain resulting in n/v colored/rainbow halos dilated & fixed pupil injected conjunctiva EMERGENCY! can cause permanent blindness if 24-48h! necessitates aggressive management |
close angle glaucoma
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resembles primary open-angle
optic nerve is damaged even though IOP is NOT high & no one knows why risks: family hx, Japanese origin, systemic heart disease |
normal tension gluacoma
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what are some signs of congenital glaucoma
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hazy cornea
increased lacrimation photophobia blepharospasm |
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develops from edema, injury [hyphema], inflammation or infection, tumor, advanced cataract, diabetes
edema may inhibit outflow of aqueous humor through trabecular network delayed healing of corneal wound edges may result in epithelial cell growth into anterior chamber |
2ndary glaucoma
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determined by rate of aqueous humor production in the ciliary body & the resistance to outflow of aqueous humor
normal range = 12-22 mm Hg, may vary 2-3 mm Hg diurnal variations, highest upon awakening positional variations, highest when lying down probably higher in darkness, dilated pupils |
IOP
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explain some patho concerning glaucoma
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as aqueous fluid builds up in eye, increased IOP inhibits blood supply to optic nerve & retina
tissues become ischemic tissues lose function, i. e., vision individual response to IOP varies |
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when diagnosing glaucoma, its used to measure IOP
estimates resistance to outflow |
tonometry
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when diagnosing glaucoma, appears pale background; cupping [indented disc]
slit-lamp allows magnified examination of eye structures red conjunctiva, corneal cloudiness, turbid aqueous humor, flare [protein], cells, nonrx pupil, increased IOP [>23] |
funduscopy
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used to determine depth of anterior chamber angle & any abnormalities in filtering meshwork
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gonioscopy
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how often should one get assesses if the have a family history of glaucoma
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every 2 yrs after age 40
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what are some goals of treatment with glaucoma
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facilitate outflow of aqueous humor through remaining channels & maintain IOP in a safe, nondamaging range
if IOP high, must be lowered to preserve vision if vision lost, must restore independence [rehab] |
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what is the function of topical miotics
with glaucoma |
(or epinephrine) constrict pupil, open canal of Schlemm, promote drainage
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what is the function of topical beta-blockers, alpha-adrenergic agents, or oral carbonic anhydrase inhibitors
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reduce aqueous humor production
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what is the function of prostaglandin agonists
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increase uveoscleral outflow of aqueous humor
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what may be given for glaucoma in an emergency situation
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oral diuretic
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what are some adverse effects of glaucoma meds
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may cause blurred vision and decreased night vision
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why are mydriatic agents contraindicated with glaucoma
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dilate the pupil by inhibiting parasympathetic nervous system & blocking acetylcholine
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why are cycloplegic agents contraindicated with glaucoma
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paralyze ciliary muscle & dilator muscle of iris, causing both pupillary dilation & paralysis of accommodation
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what is wrong with the pupils dilating when concerning glaucom
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it restricts the outflow of aques humor
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type of glaucoma surgery that
produces a nonpenetrating thermal burn on trabecular meshwork that changes its configuration, increases its tension, and leads to outflow of aqueous humor |
argon laser trabeculoplasty (ALT)
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what type og glaucoma surgery
creates an opening at the limbus under a partial-thickness scleral flap opening circumvents the obstruction, & aqueous humor flows into subjunctival spaces fibrosis can occur treated with antimetabolites |
trabeculectomy
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what might be needed by the client post op glaucoma to protect the eye
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eye patch and metal or plastic shield
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what does a post op glaucoma pt need to know
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- avoid lying on operated side
- s/s increased IOP |
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lens opacity
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cataract
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some degree in most people >70
worldwide, primary cause of reduced vision & preventable blindness >1 million cataract operations/year; most common surgery |
cataract
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what are the different types of cataract
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congenital
traumatic 2ndary most common is age-related or senile type, begins around age 50 |
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what are some age related types of cataract
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- cortical
- nuclear sclerotic - posterior subscapular opacities |
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= spokelike opacifications in lens periphery; progress slowly; infrequently involve visual axis; usually don’t cause severe vision loss
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cortical cataract
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= progressive yellowing & hardening of central lens; most >70 have some degree
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nuclear sclerotic cataract
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= occur centrally on posterior lens capsule; early visual loss because in visual axis
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posterior subcapsular opacities
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what is the single most risk for cataract
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cumulative exposure to UV light
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characterized chemically by a reduction in oxygen update & an initial increase in water content followed by lens dehydration
photochemical process progression from immature to hypermature immature are NOT completely opaque; some light goes through, allowing useful vision mature are completely opaque; vision significantly reduced [used to be called “ripe”] hypermature lens proteins break down into short-chain polypeptides that leak through capsule, are engulfed, and may obstruct trabecular network: phacolytic glaucoma |
cataract patho
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what are some manifestations of cataract
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usually bilateral, but at different rates
blurred vision photophobia glare sometimes monocular vision usually sees better in low light when pupil is dilated, which allows for vision around a central opacity |
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how does fundoscopy help with the dx of cataract
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cloudy lens
blotchy, distorted, or absent red reflex |
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how does site lamp help with dx of cataract
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slit-lamp allows determination of type & extent
usually followed to monitor progression |
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how is cataract corrected
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surgery
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when is cataract surgery done
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when ADLs become impaired
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what is the most common cataract surgery
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extracapsular cataract extraction
leaves posterior lens capsule intact usually includes intraocular lens implant |
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dressing + noc shield
review monocular vision eye gtts/ungs as prescribed sunglasses moderate exercise, no driving, no heavy lifting, no sex till . . . peripheral vision decreases without lens implant |
cataract post op
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what are some complications with cataract surgery
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infection
bleeding elevated IOP, 2ndary glaucoma long-term aphakia predisposes to retinal detachment danger s/sxs = drainage, increased tearing, decreased visual acuity, unrelieved pain |
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Separation of retina from choroid
deprives blood supply loses function May occur over long period or suddenly May lead to blindness |
retinal detachment
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what is the most common RD
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Rhegmatogenous retinal detachment, most common
retinal hole, fluid accumulation, separation from blood supply |
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what are some predisposing factors of RD
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aging, cataract extraction, retinal degeneration, trauma, severe myopia, previous RD in other eye, family hx
2ndary to diabetic retinopathy, injury, vitreous body atrophy |
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what are some manifestations of RD
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aging, cataract extraction, retinal degeneration, trauma, severe myopia, previous RD in other eye, family hx
2ndary to diabetic retinopathy, injury, vitreous body atrophy |
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how is RD dx
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Eye must be widely dilated
light will be very bright Scleral depressor may be used to move eyeball Detached areas look blue-grey; usually horseshoe but may be round |
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what is RD surgery suppose to accomplish
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Surgery to place retina back in contact with choroid & seal accompanying holes & breaks pp. 1707-1708
90% success types cryopexy [cold-probe fixation] pneumatic retinopexy best for upper detachment laser photocoagulation vitrectomy scleral buckling |
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which RD surgical procedure stimulate scar formation
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cryopexy
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which RD surgical procedure is best for upper detachment and uses gas bubles
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pneumatic retinopexy
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what laser RD surgery seals the edges
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photocoagulation
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what are some things to do pre op
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Explore client expectations
Provide info re: vision loss vision may take a while to improve or it may not if loss; expect & support grief process goal = autonomous lifestyle; QOL Explain re: postop care eye patch & shield [monocular vision] positioning diversion Advise re: eye care, danger s/sxs |
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describe some RD postop nursing care
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Assess level of IOP, pain, nausea, inflammation
medicate as ordered cycloplegics, alpha-agonists, analgesics, antiemetics, antibiotics, corticosteroids, etc. cold compresses dim lights/sunglasses diversion mind-body-spirit support Position appropriately e.g., bubble may require face down & to one side x several days [or weeks] 40 minutes every hour [special bed/chair] bubble has to be UP Advise re: eye care, danger s/sxs |
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progressive disorder of retina characterized by microscopic damage to retinal vessels, resulting in occlusion
inadequate blood supply results in retinal deterioration & permanent vision loss |
diabetic retiopathy
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what are the different types of diabetic retinopathy
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- nonproliferative/ background
- proliferative |
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retinal vessels are hyperpermeable & weak
capillaries develop microaneurysms retinal veins become dilated & tortuous multiple hemorrhages retinal edema caused by leaking capillaries impaired vision results |
nonproliferative/background diabetic retinopathy
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progressive retinal edema stimulates the growth of new but ineffective blood vessels
these grow into vitreous body may cause RD microinfarcts of nerve fiber “cotton-wool” patches or spots |
proliferative diabetic retinopathy
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what are some manifestations of retinopathy
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“spiders,” “cobwebs,” tiny specks floating
dark streaks or red film that blocks vision vision loss, usually OU blurred vision that may fluctuate decreased noc vision dark or empty spot in center of vision difficulty adjusting from bright to dim |
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what is the treatment for diabetic retinopathy
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goal = slow or stop progression
Photocoagulation stop leakage of blood & fluid in retina &, therefore, slow progression Vitrectomy removal of blood-filled vitreous |
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removal of blood-filled vitreous
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Vitrectomy
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what are some things to explain to client about diabetic retinopathy
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blurry vision x 1 day
spots from laser will disappear over time mild pain, headache, photosensitivity OTC analgesic eye patch [monocular vision] retreatment prn |
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genetic disorder
earliest sx = noc blindness then, peripheral vision loss eventually, central vision loss legally blind by 60 NO tx |
retinitis pigmentosa
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most common causes are emboli that result in sudden, unilateral, painless loss of vision [total or partial]
if early phase, anticoagulant emergency management m.d. massage of eyeball to move embolus surgery e.g., anterior chamber paracentesis to decrease IOP & move embolus |
retinal vascular occlusion
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what is the management of retinal occlusion in an emergency situation
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m.d. massage of eyeball to move embolus
surgery e.g., anterior chamber paracentesis to decrease IOP & move embolus |
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group of hereditary & acquired disorders of unknown origin
characterized by deposits in the layers [5] of the cornea & alteration of corneal structure |
corneal dystrophy
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what are some common causes of corneal dystrophy
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- corneal ulcers
- lacerations - burns - keratoconus - Fuch's dystrophy |
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corneal dystrophy which is inherited, usually women
usually begins in 20s & 30s slowly progressive deposits that look like warts in Descemet’s membrane early sxs = glare & photosensitivity blurred vision upon awakening sharper later as corneal moisture evaporates after lids open |
Fuch's dystrophy
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how is Fuch's dystrophy diagnosed
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slit-lamp exam with fluorescein to enhance surface visualization
corneal scrapings may be taken with sterile spatula |
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what is the goal of treatment of Fuch's dystrophy
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goal is to restore visual clarity for safety & QOL
decrease blurriness due to edema |
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how is Fuch's dystrophy treated
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saline eyegtts & ung to draw fluid out of cornea
at arm’s length, blow air from hair dryer with eyes closed to reduce edema corneal transplantation AKA penetrating keratoplasty (PK), corneal grafts |
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which glaucoma surgery can fibrosis occur with
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trabeculectomy
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what is the treatment for fibrosis when dealng with glaucoma
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antimetabolites
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what is the single most risk for cataract
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exposure to UV light
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characterized chemically by a reduction in oxygen update & an initial increase in water content followed by lens dehydration
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cataract
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lens proteins break down into short-chain polypeptides that leak through capsule, are engulfed, and may obstruct trabecular network: phacolytic glaucoma
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hypermature cataract
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what is the first sign of retinitis pigmentosa and what makes it different from the other eye conditions
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night blindness
- it is a genetic disorder |
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what is the most common cause for retinal vascular occlusion
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most common causes are emboli that result in sudden, unilateral, painless loss of vision [total or partial]
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how do you treat retinal vascular occlusion in the early phase
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anticoagulant
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keratoconus
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inherited thinning of the cornea
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